Factors associated with parathyroid hormone control in haemodialysis patients with secondary hyperparathyroidism treated with cinacalcet in real-world clinical practice: Mimosa study

Autor:	Pablo Ureña-Torres, Jacques Rottembourg, Abdelaziz Hamani, Daniel Toledano, Corinne Emery, Victor Gueutin, Hedia Hebibi, Olivier Coldefy, Thomas Guincestre
Rok vydání:	2019
Předmět:	medicine.medical_specialty Cinacalcet medicine.medical_treatment 030232 urology & nephrology Urology Parathyroid hormone 030204 cardiovascular system & hematology cinacalcet compliance 03 medical and health sciences 0302 clinical medicine secondary hyperparathyroidism CKD-Mbd Mimosa study medicine Dialysis KDIGO Transplantation business.industry Retrospective cohort study medicine.disease Clinical Practice Nephrology Secondary hyperparathyroidism Hemodialysis business Kidney disease medicine.drug
Zdroj:	Clinical Kidney Journal
ISSN:	2048-8513 2048-8505
DOI:	10.1093/ckj/sfz021
Popis:	Background Secondary hyperparathyroidism (SHPT) is frequent in haemodialysis (HD) patients. Oral cinacalcet-hydrochloride (HCl) decreases parathyroid hormone (PTH); however, real-life PTH data, according to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, are still lacking. Our goal is to assess the percentage of cinacalcet-HCl-treated HD patients with controlled SHPT (PTH Methods This is a retrospective observational study in HD patients with SHPT treated by cinacalcet-HCl between 2005 and 2015 and dialysed in seven French HD centres using the same database (Hemodial™). Results The study included 1268 patients with a mean (standard deviation) follow-up of 21 ± 12 months. Their mean dialysis vintage was 4.3 ± 5.6 years. PTH values were available and exploitable at M12 in 50% of them (645 patients). Among these patients, 58.9% had controlled (mean PTH of 304 ± 158 pg/mL) and 41.1% uncontrolled SHPT (mean PTH of 1084 ± 543) at M12. At the baseline, patients with controlled SHPT were older (66 ± 15 versus 61 ± 17 years), and had lower PTH (831 ± 346 versus 1057 ± 480 pg/mL) and calcaemia (2.18 ± 0.2 versus 2.22 ± 0.19 mmol/L) than uncontrolled patients. In multivariate analysis, these three factors still remained significantly associated with controlled SHPT. Conclusion In this real-life study, 41.1% of HD patients with SHPT treated with cinacalcet-HCl remained with a PTH above the KDIGO recommended target after 12 months of treatment. Apart from the possibility of non-compliance, the severity of SHPT appears to be a major factor determining the response to cinacalcet-HCl treatment, reinforcing the importance of treating SHPT at earlier stages.
Databáze:	OpenAIRE
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